Provider Demographics
NPI:1578859393
Name:WORTHINGTON, HEATHER (PAC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:HANDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5920
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0911
Mailing Address - Country:US
Mailing Address - Phone:307-660-3707
Mailing Address - Fax:
Practice Address - Street 1:1125 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164-8803
Practice Address - Country:US
Practice Address - Phone:509-335-3575
Practice Address - Fax:509-335-6223
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1098019363AM0700X
ORPA158537363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1098019OtherNCCPA
ORR166197Medicare PIN